Between bench and bedside

When Maria João Cardoso arrived at the Champalimaud Foundation (CF) in 2011, the building was almost empty. “There was almost no one there”, she recalls. “It was a ghost institution that progressively came to life”.

At the time, her surgical team was still operating at Lisbon’s Red Cross Hospital while the Champalimaud Clinical Centre was being built. “We were already seeing patients and doing consultations at the CF, but the inpatient facilities and operating theatres for breast unit patients only became available around 2016. There were only about ten of us at the start, and we were like a family. Now we’re around 60! Normally in your career you go from one hospital department to another – you don’t get to build one from scratch!”.

Those early days were full of improvisation. “We didn’t even have a cafeteria. Darwin’s Café, the on-site restaurant, wasn’t open to the public yet, so we used to bring food from home and sit at the fancy tables there, eating together like it was our own kitchen”.

As Coordinator of the Breast Unit Surgical Team, Maria João helped design the unit’s most distinctive feature: its integrated clinical model. “In most hospitals, breast cancer patients move from one department to another – surgery, oncology, radiology – which meet periodically to discuss each case”, she explains. “Here, we bring specialists together around the patient, and they work side by side as part of the same team. We adapt to the patient, not the other way around”.

“We still have room to improve”, she adds. “Ideally, a patient could meet the surgeon and nurse in a single appointment, instead of making two separate visits. Hospitals usually optimise the time of doctors, not patients – but here, we try to do the opposite”. 

This patient-centred model has since been adopted across other units at the CF, and the same mindset also drives her research. Her long-standing work on the cosmetic and psychological outcomes of breast cancer surgery took on new life in 2022 with the launch of the European Commission-funded CINDERELLA project. Using artificial intelligence, the project allows patients to visualise the aesthetic results of different surgical techniques before their operation.

“Most patients now live long, healthy lives after breast cancer”, she says. “So we need to understand the consequences of surgery not just in medical terms, but in how women feel about their bodies and their quality of life. The success of treatment cannot be measured only in years gained. Most patients say they’re happy with their results, but that’s often because they don’t know what alternatives exist. CINDERELLA gives them the tools to make informed choices”.

One patient’s decision has stayed with Maria João. “She needed surgery for a small tumour and had large breasts for her size. I showed her simulations of two surgical options – one simpler, and one more interventional that would reduce breast size and make radiotherapy easier. I expected her to choose the latter, but she said, ‘That’s just not me. I can’t see myself with that new body’”. Maria João pauses. “That’s what this is about, giving patients the knowledge and confidence to choose what feels right for them”.

In 2025, she launched the Breast Cancer Research Programme, a long-envisioned effort to connect basic and translational research with clinical practice – introducing new techniques and more personalised treatments to better serve patients. “We’ve built a small team – a programme manager, a statistician, a communications officer, a secretary. For clinicians who spend their days seeing patients, writing grant proposals is rarely feasible. The new programme fills that gap, helping doctors turn clinical questions into research projects”.

“We aim to become a major clinical research programme with biobanks, strong data analysis capabilities, and health-science management that connects directly with IT. Until recently, I was handling every request myself, from equipment to services”. She sees the programme as a model for how clinical units can evolve into spaces for research and innovation. “We started with the Breast Unit, but this approach could extend to other clinical areas at CF – and to hospitals elsewhere”.

The programme has already attracted over €1.5 million in funding, applied for five European grants, published 37 papers, and initiated new collaborations with CF research groups. It is now working towards formal internal recognition as a research unit within the CF – a status that would provide clearer structure and open additional avenues for dedicated research funding. The programme is also strengthening its integration into Champalimaud Research, the Foundation’s basic and translational research arm, to make it easier for clinical researchers to access shared scientific facilities.

“In theory, working in a clinic that’s also a research centre should be easy”, she says. “In practice, it’s not – the support systems and email addresses, even the infrastructure are separate. But people here are inventive. With goodwill, we find ways to make it work”.

Looking ahead, Maria João hopes the Breast Cancer Research Programme will set a precedent for other clinical units at the CF – one where the boundaries between lab and clinic dissolve. “I hope we truly become a fusion-research institution – one where ideas flow both ways, from patient to scientist and back again”, she says. “And of course, I hope CINDERELLA keeps evolving until every patient, everywhere, can benefit from it. Patients already come to the CF asking if they can join the trial – I want a future where it’s not a trial, but something accessible to everyone”.

As she looks ahead, Maria João is both pragmatic and hopeful. “We work in a truly unique place, with clinics and research facilities under the same roof. I hope we can take full advantage of this”.

And if she had to name what she’d miss most if she ever left the CF? “Everything”, she says. “The space, the people, the light – and the feeling that we are building something that truly changes lives”.
 

Maria João Cardoso, Head Breast Surgeon at the Breast Unit, Director of the Breast Cancer Research Programme, Champalimaud Foundation.

Text by Hedi Young, Science Writer and Content Developer of the Champalimaud Foundation's Communication, Events & Outreach Team
 

Full 20 Years, 20 Stories Collection here.